O edema macular sempre volta mesmo fazendo injeção intravítrea.

I've had several intravitreal injections and the macular edema always returns. What can be done? In today's video, Dr. Mário Bulla, an ophthalmologist specializing in retina, will talk about this problem that greatly affects diabetics: macular edema. Macular edema is part of diabetic retinopathy and means that our macula, which is the center of vision, the center of the retina, is becoming swollen, accumulating excess fluid. Macular edema is the main cause of worsening vision in diabetic patients. Of course, vision can worsen for other reasons, such as vitreous hemorrhage or even a traditional retinal detachment, but the most common cause of poor vision in diabetic patients is macular edema. Macular edema is an entity that was very difficult to treat a few decades ago because the only weapon available for treating diabetic retinopathy was laser photocoagulation. Although laser treatment has relatively good effectiveness in proliferative retinopathy, which is where new blood vessels begin to grow in the retina, They can bleed and detach the retina for macular edema. In most cases, laser treatment is not very effective, except for some cases of focal macular edema where we can detect exactly which microaneurysm is leaking fluid. In those cases, laser treatment can be beneficial, but mainly when there is more diffuse edema, laser treatment did not bring a very good result. So, about 15 years ago, they started to perform intravitreal injections of anti-angiogenic drugs, which are medications that bind to specific receptors in the retinal circulation and improve not only macular edema but also the proliferation of neovessels in the retina. It is used not only in patients who have diabetic retinopathy but also in cases of exudative macular degeneration, cases of macular edema due to venous occlusion, and also neovascular membranes from other causes. In the specific case of diabetic macular edema, intravitreal injections of anti-angiogenic drugs can improve vision. of the patient and stabilize the condition in a large number of cases, but of course unfortunately there are some patients who do not respond very well to treatment and currently we have two medications that are most used which are Lucentis and Eylea and also another alternative which is Avastin and in cases where these medications fail there is also Ozurdex which is a slow-release implant of dexamethasone which is a corticosteroid that is released over four months inside the eye and subsequently some cases that are very resistant to treatment with antiangiogenics show a good response to Ozurdex, but today I am not so rare, of course we would like the intervals between injections to be longer and longer and this happens in a large number of patients, currently we use a protocol called treat and extend in which we start the injections by taking three monthly injections of antiangiogenic and if the patient shows a good result we gradually increase this interval and try again after a few Three or four months apart, if the edema does not return, stop the treatment, of course, always closely monitoring to observe the patient's body's response. This response is very variable; there are patients who respond very well to the first injection, there are patients who require more than three injections to show any response, but this recurrence or return of the edema is relatively common, and it is important to highlight that there are some studies showing that diabetes control is important in the outcome of the treatment. Of course, we will not contraindicate treatment with antibiotics if diabetes is not well controlled, but we know that if blood glucose is well controlled, the response to treatment will be better. So in this type of situation, it is always good to assess whether the patient's diabetes is very uncontrolled. It is also interesting to evaluate the periphery of the retina, perhaps with an angiography exam, to see if there is any. Follow us on Instagram:   / retina.bulla   This video and its comments do not replace a medical consultation and are for educational purposes only. They should not be used for decision-making; a face-to-face consultation with a specialist physician is necessary for that. Author: Dr. Mário César Bulla Cremers 28120 Ophthalmologist - Retinologist www.clinicabulla.com.br www.especialistaemretina.com.br Instagram: @retina.bulla Video URL:    • O edema macular sempre volta mesmo fazendo...   @Retina e Vítreo #retina​​​​​​​ #ophthalmology​​​​​​​ #vision 0:00 Introduction 0:25 Presentation 5:58 Acknowledgments